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Hospitals adding urgent cares to expand care

According to the Urgent Care Association of America, 53% of insured Americans have expressed difficulty in getting same- or next-day access to a health care provider, mainly because primary care providers’ schedules are so full, same-day scheduling is difficult.

It can explain why a 2016 poll by NPR, the Robert Wood Johnson Foundation and the T.H. Chan School of Public Health at Harvard University found that 27% of Americans have received health care at one of the more than 7,000 urgent care facilities across the country in the last two years.

Hospitals, in an effort to keep non-emergency patients out of their emergency rooms, have started to take notice of the trend that more and more patients are electing care from an urgent care facility over a primary care provider.

In fact, Bon Secours St. Francis franchised four Upstate urgent care facilities previously owned by American Family Care in 2015. The hospital group opened Bon Secours Express Care on McBee Street in downtown Greenville in 2014 and repurposed it in 2015.

“A lot of care is being patient-driven and patients want care outside of our traditional office hours,” said Dr. Marcus Blackstone, senior group lead physician for primary care at Bon Secours St. Francis. “We not only do regular care, but occupational care for businesses.”

Greenville Health System is no exception. Jim Ellis, vice president of clinical affairs at GHS, said the hospital has opened four of its MD360 urgent care practices with a fifth under construction and expected to be complete in March. Its first MD360 office was opened in 2009 in Simpsonville.

“At that time, Dr. (GHS chief academic officer Jerry) Youkey was the senior physician at the time and he saw a national trend for urgent care services,” Ellis said. “A part of that was due to a lack of access to primary care and the increase in emergency room visits.

“There are instances where people will go to the emergency room that really don’t need to be in the emergency room.”

From 2013 to 2014, emergency room visits in South Carolina went from 330 per 1,000 to 459 per 1,000, according to The Henry J. Kaiser Family Foundation. Hospital groups like GHS and Bon Secours St. Francis hope to reverse the trend and direct non-emergency medical visits to an urgent care.

Changing the model

Primary care physician visits are based on several factors, but the biggest is time.

The Urgent Care Association found that the average wait time at an urgent care facility is 30 minutes or less and around 60 minutes from start to finish for a visit. Additionally, 96% of urgent care facilities across the country are open seven days a week, according to a 2015 benchmark study by the UCA.

That, coupled with the expansion of services provided by an urgent care, such as care for common illnesses like the flu and colds, and treatments for sprains and minor broken bones, is what has led hospital groups to dive deeper into the urgent care market.

“There are different levels of complexity,” Blackstone said. “You might have to wait 30-45 minutes in a doctor’s office and a lot of the urgent care has been driven by the quick things that used to be bread and butter in our business.

“Someone figured out that those things can be treated a different way.”

Another trend leading hospitals into the urgent care business is society.

“We see a lot of young adults between 20 and 45 years old that don’t have any significant health issues and really don’t want a primary care physician and they use the urgent care to get their medical care,” Ellis said.

He added that GHS is seeing an increase in urgent care patients in their 30s and 40s, saying, “the days of people going in for those yearly physicals are just not there anymore.”

The urgent care model also provides hospitals like Bon Secours and GHS the ability to decrease staffing costs.

“This model is staffed completely different and we are able to provide the same or similar services with less staff,” Blackstone said. “Some of the more basic things we see are turned around much quicker, so those are up-sides as far as the numbers.”

Additional benefit

A hope of hospitals operating urgent care facilities is to reduce the number of patients entering emergency rooms with non-life threatening illnesses.

But, urgent cares offer hospitals like Bon Secours St. Francis and GHS opportunities to get patients into their respective systems.

“If you think about it, someone moves to town and they look for a primary care physician and can’t get in, they may go to an urgent care and then get referred to a primary care physician in the system,” Ellis said. “It is much easier to be screened before going to someone like an orthopedic surgeon and we can even make sure that is the direction you need to go.”

Patients visiting urgent care facilities not owned by hospitals would still have to go through the paces of getting into a hospital’s records.

Blackstone said the new process shortens the time for a patient to get into the hospital’s records system and increases the ability to bring new patients into the primary care fold.

“We are wanting to create new doors for patients to enter our systems and urgent care gives you a wide open door,” Blackstone said. “When they come through, we really try to get them into one of our primary care physicians.”

Ellis said it is easy to get someone in the system at an urgent care facility into a specialist because of increased networking between hospital groups and physicians.

“I know that anyone who comes in to be seen, I can just pick up the phone and get them into a cardiologist or cancer specialist because they are our partners,” Ellis said. “I have 1,895 partners in the system.”

The future of the model

Both Ellis and Blackstone agree the urgent care business will continue to grow. While the group won’t make any predictions, the Urgent Care Association of America said “there is no indication that this (growth rate) will slow down any time in the near future.”

Bon Secours St. Francis is planning to open AFC Urgent Care facility on Pelham Road sometime this year and Greenville Health System is finishing its fifth MD360 facility which is expected to be done in March.

“We need to have people at the right place for their care and the right cost center for their care,” Ellis said. “If you don’t need to go to the emergency department, which tends to be a higher cost center, then patients need to know that.”

Urgent care facilities are just one of many new avenues hospitals are exploring to put patients in the right area for treatment. Other advances such as telemedicine are providing another tool for hospitals and physicians to reach out to patients at the convenience of the patient.

“Long term, our connectivity across the system will allow patients to call in to a call center and be referred to the best possible place for them to get the care they need,” Ellis said. “That future could also include telemedicine where you make a call and talk to a nurse and even do a video chat to find out what can be done. It is more about getting the patient in the right place.”